Quality of the estimate. December, p. 47 - Health Care Compliance ...

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Accountability is the key to compliance effectiveness ...continued from page 53 December 2011 54 compliance officer, and others designated to carry out the day-today functions of the compliance program. Effective implementation of the seven elements means going beyond mere adoption of standards and policies to integrating compliance principles into the business activity of the organization at all levels. In order to receive credit for maintaining an effective compliance program under the Federal Sentencing Guidelines, the new amendment adopted in 2010 sets forth four criteria that must be evident when members of senior management are involved with, condoned, or willfully ignored the criminal activity: n The compliance officer is required to and has, in fact, reported directly to the governing body or a designated subcommittee thereof. n The compliance program was effective in discovering the criminal activity before it was discovered by or was likely to be discovered by governmental authorities. n The organization self-reported the offense to the appropriate federal agency. n No compliance officials were complicit with, condoned, or willfully ignored the criminal activity. 3 In addition, the organization may receive credit for making timely restitution to victims. This is a two-pronged process. To receive credit, the organization must not only remedy the harm done, but must have made demonstrable changes to its compliance program to prevent recurrences. Accountability As previously noted, the Federal Sentencing Guidelines provide incentives, such as favorable sentencing benefits, for organizations that can demonstrate an effective compliance program to prevent and detect violations. The key term is “effective.” Adopting a welldefined compliance program and giving it lip service is simply not enough. Organizational compliance programs must become part and parcel with the fabric of the entity at all levels—starting with the governing body and extending to entry-level staff and volunteers. And, to obtain favorable treatment under the Federal Sentencing Guidelines, organizations must be able to prove the effectiveness of their compliance programs. The 1998 Compliance Program Guidance for Hospitals issued by the OIG, as reinforced with supplemental guidance issued in 2005, sets forth the expectation for every provider to periodically assess the effectiveness of its compliance program. The assessment should be completed no less than once a year. Many health care providers perform a self-assessment. Although Health Care Compliance Association • 888-580-8373 • www.hcca-info.org reviewing your own program will be considered more favorably than failing to do so altogether, selfevaluations are fraught with the shortcomings that lack of objectivity brings to any monitoring or auditing activity. Self-reviews are frequently overseen by the compliance officer who is charged with the overall responsibility for the success of the compliance program in the first place, thus creating a conflict with the need to disclose inadequacies that may reflect poorly on the compliance officer’s personal job performance. Having an independent review of the effectiveness of the compliance program, performed by a qualified outside consultant, can yield big benefits for any health care organization. An independent review provides the kind of outside accountability needed to ensure the success of the compliance program. Engaging the review can demonstrate to the governing body how seriously the compliance officer takes his/her responsibilities. Outside reviewers bring in fresh ideas and leverage a knowledge base otherwise inaccessible to the organization’s compliance program. By implementing objective recommendations coming out of the assessment, the compliance officer adds value to the organization he/she serves, supporting the continuous quality improvement culture found in top-notch health care organizations.
Regulatory compliance for research in an academic medical center ...continued from page 37 In addition to overall compliance program effectiveness reviews, organizations can benefit from targeted monitoring by independent experts. For organizations that have detected violations, the 2010 amendment to the Federal Sentencing Guidelines permits a health care organization to decide whether to retain an independent monitor to ensure that changes to the compliance program which were designed to prevent recurrences have been effectively implemented. 3 This form of accountability will be seen quite favorably when serious infractions have been discovered and will demonstrate to the government that the organization is serious about remediating the harm done and preventing future misconduct. Having an effective compliance program not only reduces the likelihood of fines and penalties in the event of a government investigation, but it protects the organization’s public image and reputation from damage and fosters trust by investors, patients, and the community. n 1. United States Sentencing Guidelines, Chapter 8, Subsection 8A1.2 2. Publication of Compliance Program Guidance for Hospitals, Federal Register, Vol. 63, No. 35, Monday, February 23, 1998/ Notices 3. US Sentencing Commission, Amendment to the Sentencing Guidelines at 17-18 (April 30, 2010) completed per month increased by 250%. Federal and state awards increased by more than 200% in three years, and the number of research projects that are part of the residency training programs increased 375%. These increases occurred as a consequence of the institution’s commitment to growth in capacity and resources for the Department of Research. A strategy was developed for systems, policies, and processes that required prioritization in development and implementation. Also, a focus was placed on education before regulation to identify appropriate growth of research administration functions. The steps outlined in this article reflect the experience of this institution and Department of Research, but should have applicability to other standalone academic medical centers. n 1. Elliott C. Kulakowski and Lynne U. Chronister: Research Administration and Management. Jones and Bartlett Publishers, 2006. 2. Goldenberg NA, Spyropoulos AC, Halperin JL, et al: Antithrombotic Trials Leadership and Steering Group. Improving academic leadership and oversight in large industry-sponsored clinical trials: the ARO-CRO model. Blood; 2011 Feb 17;117(7):2089-92. 3. Campbell, JM: Assessing and managing research compliance risks in the health care setting. Compliance Today, 12(11):20-25, 2010. 4. EpicCare EMR is a product of Epic. More information at http://www.epic.com/ software-ambulatory.php Health Care Auditing & Monitoring Tools More than 100 sample policies, procedures, guidelines, and forms to enhance your compliance auditing and monitoring efforts. Updated biannually with new tools. For more information, visit www.hcca-info.org/books, or call 888-580-8373. Health Care Compliance Association • 888-580-8373 • www.hcca-info.org December 2011 55
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Volume Thirteen Number Twelve Decem
Page 3 and 4: INSIDE 5 The rising tide: Recognizi
Page 5 and 6: The rising tide: Recognizing your c
Page 7 and 8: Legal function of any consulting ar
Page 9 and 10: side and show that proper actions w
Page 11 and 12: If you disagree with the requested
Page 13 and 14: n Starting from Scratch o I just re
Page 15 and 16: CFO was particularly timely in ligh
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Page 19 and 20: Social Networking John Falcetano Ed
Page 21 and 22: y the federal and state agencies th
Page 23 and 24: People on the Move Former Medicaid
Page 25 and 26: may find themselves in a netherworl
Page 27 and 28: Losing sleep over health care marke
Page 29 and 30: Editor’s note: Jeffrey N. Joyce i
Page 31 and 32: The first domain for establishing r
Page 33 and 34: for research services provided by p
Page 35 and 36: Community Relations. A process to r
Page 37 and 38: With the implementation of the EMR
Page 39 and 40: showed that the company viewed its
Page 41 and 42: Healthcare facilities that are seri
Page 43 and 44: CCB The Compliance Professional’s
Page 45 and 46: Legislators viewed the Medicare RAC
Page 47 and 48: Confidence and precision in claims
Page 49 and 50: universe is no less than $9,650. No
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Page 73 and 74: New HCCA Members Alabama n Patricia
Page 75 and 76: What could you do with The Power of
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